脾臟切除術後併發腸系膜靜脈栓塞症

脾臟切除術後的主要併發症不外乎(1)感染(2)血栓栓塞症 (thromboembolism)。後者通常發在於周邊血管，形成深部靜脈栓塞，至於發生在腸系膜靜脈造成腸壞疽是一罕見的合併症(1) 。目前，已有報告病例多屬於血液病患而接受脾臟切除術者。本文報告一位非血液病患者，其為57歲女性，因上消化道出血而經支持性保守療法無效，而接受手術，由於胃平滑肌瘤出血及脾臟鈣化囊腫而施予胃部份切除術及脾臟切除術。術後，情況趨於穩定，且不再有消化道出血。但術後第8日，再度因突發的腹痛，腹脹，高燒，盜汗，血壓下降及麻痺性腸阻塞，且抽出含不凝血的惡臭腹水而進行剖腹探查，發現腸系膜靜脈栓塞併空腸壞疽，術中將壞疽的空腸切除，但於12小時後，因無法改善的敗血症死亡。因病例之罕見，特提出報告，並參考文獻以討論之。

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並列摘要

The two major complications following a splenectomy are infection and thromboembolism. The latter commonly develops in the peripheral venous system as a postoperative deep vein thrombosis, whereas the occurance of venous occlusion involving the splanchnic venous circulation represents an uncommon complication. Literature concerning portal and mesenteric venous thrombosis following splenectomy have occurred predominantly in patients with hematologic disorders. An experience with one instance of postsplenectomy mesenteric venous thrombosis with jejunal gangrene in a patient without hematologic abnormalities is herein reported. A 57 year-old female suffered from hematemesis and melena 3 days prior to her admission. In spite of intensive conservative treatments for upper gastrointestinal bleeding, the hemorrhage persisted. She underwent laparotomy with partial gastrectomy and splenectomy for bleeding gastric leiomyoma and a calcified splenic cyst. Initially she had done well until 8 days postoperatively when evidences of sepsis, paralytic ileus and foul bloody ascites. An exploratory laparotomy revealed jejunal gangrene with mesenteric venous thrombosis. Resection of gangrenous bowel with end-to-end anastomosis was done. She died 12 hours after the operative procedure due to irreversible shock caused by a combination of sepsis and third space fluid accumulation.

並列關鍵字

mesenteric venous thrombosis ； splenectomy

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脾臟切除術後併發腸系膜靜脈栓塞症

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